BIRTHPLACE AND COGNITION AMONG US OLDER ADULTS: EVIDENCE FROM THE HARMONIZED COGNITIVE ASSESSMENT PROTOCOL (HCAP)

Abstract Growing evidence shows that place of birth and related circumstances may impose lasting and multiplicative impacts on a host of late-life outcomes; yet how it affects various domains of cognitive function in late-life is less understood. In this paper, we exploit the comprehensive cognitive assessments in the Health and Retirement Study (HRS) Harmonized Cognitive Assessment Protocol (HCAP) and HRS geographic data at birth to determine to what extent birth location measured at the state level is associated with cognitive status in later life for a representative sample of Americans over age 50 (N=3,324). We found that state of birth significantly influenced various cognitive domains later in life (including episodic memory, executive function, attention, visuospatial function, language fluency and orientation); and the regional rankings tended to be highly consistent across the cognitive assessments in each domain. Regression analysis demonstrated that the geographic disparities in cognition across birth states could be partly explained by the late-life differences in socioeconomic statuses. Nevertheless, Shapley decompositions demonstrated that, after accounting for mid-life to late-life factors, state of birth still contributed 20%-30% of the explained variations in cognitive outcomes. Particularly, foreign-born individuals and those born in the southern states tended to score the lowest on average on each of the cognitive tests/domains and can account for most of the explained differences in cognition. These findings suggest that place of birth may have lasting impacts on disparities in cognition later in life. Public policy should play pivotal roles in leveling the playing field in early life.

Older Adult Caregiving Supports (COACH) program was developed as a strengths-based person-centered caregiver support intervention, built on evidence-based prevention approaches used in other types of family violence.In a double-blind randomized controlled trial, family caregivers (n=80) of older adults aged 65 and older who were members of Kaiser Permanente completed surveys at baseline, post-test, and three-month follow-up.The primary outcome was elder mistreatment; additional proximal outcomes were caregiver burden, quality-of-life, anxiety, and depression.All analyses were conducted using nonparametric tests.The treatment group had no mistreatment at 3-month follow-up, a significantly lower rate than the control group (treatment=0%, control=23.08%,p=0.010).Among the proximal outcomes, a significant difference in social quality-of-life was seen at post-test but did not persist to the 3-month follow-up.No further proximal outcome effects were detected.This pilot program offers a promising model to reduce elder mistreatment and its resultant impacts on the health and well-being of both caregivers and the older adults they care for.In helping to ameliorate mistreatment, COACH supports individuals providing crucial care to older adults with chronic health conditions and reduces the burden of addressing this complex condition for an already strained geriatric health and social service delivery system.

SOCIAL DETERMINANTS OF HEALTH AND AGING I
Abstract citation ID: igad104.0612

BIRTHPLACE AND COGNITION AMONG US OLDER ADULTS: EVIDENCE FROM THE HARMONIZED COGNITIVE ASSESSMENT PROTOCOL (HCAP)
Zhuoer Lin, and Xi Chen, Yale University, New Haven, Connecticut, United States Growing evidence shows that place of birth and related circumstances may impose lasting and multiplicative impacts on a host of late-life outcomes; yet how it affects various domains of cognitive function in late-life is less understood.In this paper, we exploit the comprehensive cognitive assessments in the Health and Retirement Study (HRS) Harmonized Cognitive Assessment Protocol (HCAP) and HRS geographic data at birth to determine to what extent birth location measured at the state level is associated with cognitive status in later life for a representative sample of Americans over age 50 (N=3,324).We found that state of birth significantly influenced various cognitive domains later in life (including episodic memory, executive function, attention, visuospatial function, language fluency and orientation); and the regional rankings tended to be highly consistent across the cognitive assessments in each domain.Regression analysis demonstrated that the geographic disparities in cognition across birth states could be partly explained by the late-life differences in socioeconomic statuses.Nevertheless, Shapley decompositions demonstrated that, after accounting for mid-life to late-life factors, state of birth still contributed 20%-30% of the explained variations in cognitive outcomes.Particularly, foreign-born individuals and those born in the southern states tended to score the lowest on average on each of the cognitive tests/domains and can account for most of the explained differences in cognition.These findings suggest that place of birth may have lasting impacts on disparities in cognition later in life.Public policy should play pivotal roles in leveling the playing field in early life.
The 1994 Crime Bill is a decades-old federal policy that established an infrastructure in which local governments are incentivized to fund prisons, increase average prison time, and implement adverse policing quotas.Foundational research suggests structural racism via high-contact policing and incarceration for persons racialized as Black, is associated with anxiety and depressed mood among, influencing cognitive function.Minimal research explores whether the intended beneficiaries of structural racism, persons racialized as White, have truly benefitted.We used US county-level incarceration data to compute the Black-White difference in jail and prison population rates between 1995-2005.These data were averaged by decade and linked by county to individual-level cognitive data for participants racialized as White (>50 years) in the Health and Retirement Study (N=13,016).Cognitive performance and cognitive change over time was assessed using a 27-item global cognitive score from the modified Telephone Interview for Cognitive Status for biannual years between 2006-20.A mixed effects model estimated the association of a one-unit change in county-level incarceration on cognitive performance.Greater 10-year Black-White disparities in the jail population were associated with greater cognitive performance among participants racialized as White one year later (b=0.13,95% CI: 0.02, 0.25).Findings suggest structural racism via disproportionate high-contact policing and incarceration of persons racialized as Black is linked to better cognitive function for older adults racialized as White.

SOCIAL DETERMINANTS OF COGNITIVE HEALTH: A SCOPING REVIEW
Lingling Zhang, and Yao Zhang, University of Massachusetts Boston, Boston, Massachusetts, United States Population aging has caused a substantial increase in neurodegenerative disorders, such as Alzheimer's disease (AD), the fifth leading cause of death for people aged 65 and older.It has posed tremendous challenges to families and society.The existing research shows that postponing AD onset by 5 years would reduce the disease prevalence by half.Therefore, to better understand the modifiable risk factors, including social determinants of health (SDOH) for cognitive health, will be helpful for early prevention and resource allocation.SDOH are classified into five domains (healthcare access and quality, education access and quality, social and community context, economic stability, and neighborhood and built environment).There are studies examining the relationship between one or more domains of SDOH and cognitive health, however, to our knowledge, there is no comprehensive review has been done to synthesize the evidence from all domains of SDOH.This literature review aims to map the existing evidences on social determinants of cognitive health to inform future programs and policies.Twenty-nine studies were included in the review through a systematic search of relevant literature published on peerreviewed journals from four electronic databases (Pubmed, PsychInfo, CINAHL, and MEDLINE) during 2012-2022.The review summarized a broad range of empirical research on how SDOH affect cognition, as well as revealed the racial disparities in cognitive function, which is worth noting.The favorable SDOH conditions such as better healthcare access, education, social engagement, etc. were proved protective